乳腺癌新辅助化疗疗效评价及预测的研究进展

新辅助化疗作为乳腺癌综合治疗的一项重要治疗手段,已经在临床治疗中广为应用。目前临床上对新辅助化疗疗效评价主要依靠临床触诊、影像学检测、病理学检测。随着人们对新辅助化疗的疗效评价及预测作用认识的提高,从生物学因子水平了解肿瘤的变化已成为新辅助化疗疗效评价的主要研究方向。联合多个生物学因子的多基因表达谱分析,有望能够预测新辅助化疗的疗效,为个体化治疗提供依据。     

Ki-67表达水平检测在乳腺癌新辅助化疗疗效评估中的价值

目的:回顾性分析88例乳腺癌新辅助化疗前、后Ki-67在肿瘤组织的表达情况,探讨Ki-67表达与新辅助化疗疗效的关系,评价其在乳腺癌新辅助化疗中的预测作用.方法:选取2015年9月至2016年9月河北医科大学第四医院乳腺中心收治的88例Ⅱ-Ⅲ期乳腺癌患者,检测新辅助化疗前空芯针穿刺肿瘤组织及术后标本中Ki-67的表达,分析其与新辅助化疗疗效及临床相关病理因素的关系.结果:新辅助化疗的临床总有效率为59.09%(52/88),Ki-67高表达组对化疗敏感,化疗效果明显优于Ki-67低表达组(P<0.05);新辅助化疗可明显降低Ki-67的高表达率(P<0.01);新辅助化疗后Ki-67表达下降组化疗有效率显著高于其他组(P<0.05).结论:Ki-67在乳腺肿瘤组织中的表达可作为新辅助化疗疗效临床评价指标之一,预测新辅助化疗的疗效,为个体化治疗提供依据.     

Ki-67在乳腺癌新辅助化疗中的作用及临床意义

新辅助化疗主要应用于局部晚期乳腺癌的治疗,疗效评价常用的指标为临床上缓解和病理学上缓解的程度.Ki-67是与细胞分裂增殖有关的核蛋白,已广泛应用于各种肿瘤的诊断及预后.多项临床研究资料表明Ki-67在判断乳腺癌新辅助化疗是否有效中显示出潜在的价值,现就Ki-67在乳腺癌新辅助化疗中的作用及临床意义作一综述.     

乳腺癌新辅助化疗中肿瘤标志物检测的临床意义

目的检测肿瘤标志物在新辅助化疗乳腺癌中的表达,探讨新辅助化疗患者中ER、PR、c-erbB2和Ki67的表达及临床意义.方法用免疫组织化学法检测ER、PR、c-erbB2和Ki67在89例新辅助化疗乳腺癌组织中的表达状况,分析上述指标与化疗的关系.结果新辅助化疗总有效率89.9%,其中完全缓解CR32.6%,部分缓解PR57.3%,病理完全缓解pCR17.9%,疾病稳定SD10.5%,无恶化病例.ER/PR表达与疗效有关（P〈0.05）,c-erbB2、Ki67表达与化疗疗程无关.结论激素受体阴性者对新辅助化疗的敏感性较高,新辅助化疗肿瘤标志物的检测可以为临床评价疗效判断预后提供依据.     

乳腺癌新辅助化疗的临床评价方法解析

乳腺癌新辅助化疗(NAC)最初是指对局部晚期乳腺癌患者手术治疗之前所进行的辅助化疗,目前己将该治疗扩展至肿瘤较大的可手术的乳腺癌患者,以使肿瘤降期,进而达到保乳手术治疗的目的.随着新辅助化疗在乳腺癌患者中不断推广应用,使用传统方法和影像学评价预测新辅助化疗反应,未能提供准确和可靠的数据.因此临床实践中迫切需要一种能准确评价化疗后肿瘤变化的检查方法.最近,光散射断层成像,新的生物标志物,癌基因组分析引入到临床实践,产生了初步可喜的成果.本文对乳腺癌新辅助化疗的临床评价方法进行综述.     

Apaf－1在乳腺癌治疗中的作用及意义

乳腺癌的新辅助化疗不但可以降低临床分期、提升保乳率,还可以判断化疗药物的敏感性,并指导术后化疗用药,已逐渐成为乳腺癌综合治疗的首选。但仍有少数乳腺癌患者不能从新辅助化疗中受益,预测乳腺癌新辅助治疗的获益人群,是临床中亟待解决的问题。乳腺癌新辅助化疗后的细胞凋亡指数（apop-totic index,AI）是评估乳腺癌新辅助化疗疗效的关键因素,而Apaf－1作为凋亡途径的重要一员,在细胞凋亡中起到重要的作用。本文通过乳腺癌新辅助化疗后AI值的变化,并结合Apaf－1自身的结构、分布、在凋亡途径中的作用及在各肿瘤中的表达和化疗耐药性等角度,对Apaf－1在乳腺癌治疗中的作用及意义作一综述。     

6周期AT新辅助化疗治疗乳腺癌临床疗效及其影响因素的分析

目的:探讨6周期AT方案(蒽环类联合紫杉类)新辅助化疗在乳腺癌治疗中的疗效及影响pCR 的因素.方法:回顾性分析159例顺利完成6周期AT方案患者的临床病理资料,对比治疗前后病理变化,评价其临床疗效及不良反应,并探究影响新辅助化疗达到pCR的因素.结果:159例完成6周期AT方案新辅助化疗的乳腺癌患者占同期进行新辅助化疗52.3%,总pCR为30.8%,降期率为76.1%.单因素及Logistic回归分析发现,肿瘤大小,组织学分级,ER、PR状态、HER-2表达、分子分型以及化疗的早期反应是影响pCR的重要因素,其中肿瘤≤3 cm、ER缺失、HER-2扩增、超声评价化疗早期反应阳性患者更容易达到pCR.结论:乳腺癌6周期AT方案新辅助化疗pCR率较高,超声评价的早期反应能够预测pCR,肿瘤大小以及肿瘤分子分型是影响pCR的重要因素,临床实践中需综合考虑影响因素,从而决定手术的最佳时机.     

乳腺癌新辅助治疗策略的研究进展

新辅助治疗作为乳腺癌的重要治疗手段,其适应证已不仅限于局晚期乳腺癌。病理完全缓解(pathologic complete response,pCR)与新辅助治疗后患者总生存率(overall survival,OS)及无病生存率(disease-free survival,DFS)的提高显著相关,是新辅助治疗最为客观高效的疗效评价指标。经新辅助治疗后的患者可以达到肿瘤降期、提高保乳率、有效观察肿瘤药物敏感性等重要的诊疗目的。精准的疗效分析可以帮助临床医生及时转换诊疗策略,为病人提供个体化治疗方案,避免治疗不足或过度治疗。本文综述了新辅助化疗中的去蒽环问题、HER2阳性乳腺癌新辅助靶向治疗、三阴性乳腺癌新辅助免疫治疗、手术时机及方式的选择等问题的最新研究进展。     

乳腺癌分子分型与新辅助化疗疗效关联性分析

目的乳腺癌在分子水平上特异性明显,新辅助化疗在其治疗上扮演的角色越来越重要。本研究旨在探讨乳腺癌分子分型与新辅助化疗疗效的相关性。方法回顾性分析2011-01-01-2015-12-31新疆医科大学附属肿瘤医院382例初治行新辅助化疗的乳腺癌患者的临床和病理资料,用免疫组化方法检测ER、PR、HER2和Ki-67的表达情况,判定分子分型,分析乳腺癌分子分型与新辅助化疗疗效的相关性。结果 Luminal型、HER2过表达型及三阴性型乳腺癌与临床疗效评价(χ^2=19.608,P<0.001)及病理疗效评价(χ^2=60.470,P<0.001)差异均有统计学意义的关联。三阴性型较HER2过表达型有更好组织学显著反应(χ^2=30.673,P<0.001),HER2过表达型较Luminal B型有更好的组织学显著反应,χ^2=25.480,P<0.001。临床疗效评价与病理疗效评价一致性欠佳(Kappa值≤0.40)。结论乳腺癌分子分型与新辅助化疗疗效有统计学意义的关联,HER2过表达型和三阴性型对新辅助化疗更敏感;临床疗效评价与病理疗效评价一致性欠佳。     

残余肿瘤负荷评分在乳腺癌新辅助化疗效果评价中的应用

术前新辅助化疗能降低乳腺癌的临床分期,增加手术适应证,并提高保留乳房率,为治疗乳腺癌提供新的可能。pCR被认为是评价新辅助化疗预后的主要终点,但该评价方式过于简单,且缺乏对术后治疗的指导意义。目前,连续性残余肿瘤负荷(RCB)评分已逐步推广。研究表明该评分能用于评估新辅助化疗与乳腺癌分子分型的关系。笔者就RCB评分在乳腺癌新辅助化疗效果评价中的应用和发展前景进行综述。     

Prognostic outcomes and decision-making for local-regional therapy after neoadjuvant chemotherapy: Pretreatment clinical staging or posttreatment pathologic staging?

Presurgical chemotherapy is increasingly implemented as it improves breast conservation rates and may reveal novel information about therapeutic response. However, neoadjuvant therapy raises questions about prognosis and decision making for adjuvant local-regional therapy. Current prognostic information and therapeutic treatment planning is typically based on American Joint Committee on Cancer staging information for patients treated with adjuvant therapy. This information is not readily applicable to patients treated with neoadjuvant chemotherapy, however, as neither pretreatment clinical staging data nor post-treatment pathologic data alone accurately reflect disease status. This review summarizes the implementation of a new staging system for patients receiving neoadjuvant therapy. This system combines clinical and pathologic staging factors with biologic markers to refine the prognostic assessment of patients treated with neoadjuvant therapy. Controversies related to neoadjuvant therapy and sentinel lymph node biopsy, postmastectomy radiation therapy, and breast conservation are also discussed.     

Neoadjuvant taxanes in the treatment of non-metastatic breast cancer: a systematic review

In recent years the role of neoadjuvant (primary, preoperative) chemotherapy has undergone rapid progress. Initially, neoadjuvant chemotherapy use was limited to those patients with inoperable locally advanced breast cancer in an attempt to try to down-size the tumour to make effective surgery possible. The advent of more effective chemotherapy regimens has led to an increased use of neoadjuvant therapy to shrink potentially operable tumours to allow for breast conservation when a mastectomy would have been required previously. While neoadjuvant treatment for operable tumours has indeed allowed increased rates of breast conserving surgery, it has not yet demonstrated any survival benefit over standard postoperative anthracycline-based chemotherapy. Echoing the evolution of taxane based chemotherapy from the metastatic setting through to the adjuvant situation, there has been increased interest in the role of taxanes in neoadjuvant regimens. The use of taxane-based therapies in this setting has so far shown improvements over more standard regimens in terms of clinical response rates, breast conservation, pathologic response rates, disease free survival, and overall survival. The aim of this review is to systematically summarize and interpret the results of published randomized controlled trials of neoadjuvant taxane chemotherapy for women with non-metastatic breast cancer.     

食管癌的新辅助治疗

Because the conflicting data currently available from the performed randomized trials it is very difficult to provide strict guidelines for the treatment of patients with locoregional advanced esophageal cancers. Surgery however, remains the standard of care for potentially resectable disease. Preoperative chemotherapy is still controversial with two large randomized trials resulting in two different conclusions regarding the survival benefit. Preoperative chemoradiation is also controversial since only one randomized trial showed a clear survival benefit however, the patients treated with surgery alone in this trial had an unusually poor outcome. And the study by Urba et al was not powered enough to show a clear survival benefit for patients treated with neoadjuvant chemoradiation. The results of three metaanalysis of these randomized studies show lower rate of resection, higher rate of R0-resection, more often postoperative mortality and better prognosis for patients with neoadjuvant radiochemotherapy. As a consequence one may consider offering neoadjuvant chemotherapy or neoadjuvant radiochemotherapy to patients with locallyadvanced disease under the premise that patients have a good performance status and understand the controversies about this therapeutic option. Larger trials with sufficient power to clearly detect survival benefits for patients treated with neoadjuvant chemotherapy or radiochemotherapy are necessary before this therapeutic option will be the standard of care.     

Neoadjuvant Treatment for Esophageal Cancer

Because the conflicting data currently available from the performed randomized trials it is verydifficult to provide strict guidelines for the treatment of patients with locoregional advanced esophagealcancers.Surgery however,remains the standard of care for potentially resectable disease.Preoperativechemotherapy is still controversial with two large randomized trials resulting in two different conclusionsregarding the survival benefit.Preoperative chemoradiation is also controversial since only one randomizedtrial showed a clear survival benefit however,the patients treated with surgery alone in this trial had anunusually poor outcome.And the study by Urba et al was not powered enough to show a clear survivalbenefit for patients treated with neoadjuvant chemoradiation.The results of three metaanalysis of theserandomized studies show lower rate of resection,higher rate of RO-resection,more often postoperativemortality and better prognosis for patients with neoadjuvant radiochemotherapy.As a consequence one mayconsider offering neoadjuvant chemotherapy or neoadjuvant radiochemotherapy to patients with locally-advanced disease under the premise that patients have a good performance status and understand thecontroversies about this therapeutic option.Larger trials with sufficient power to clearly detect survivalbenefits for patients treated with neoadjuvant chemotherapy or radiochemotherapy are necessary beforethis therapeutic option will be the standard of care.     

乳腺癌新辅助化疗疗效及其与生物标志物检测水平变化的相关性

目的:探讨乳腺癌新辅助化疗疗效及其与生物标志物检测水平变化的相关性。方法:通过对乳腺癌新辅助化疗患者疗效的评估以及空心针穿刺标本和手术标本的免疫组织化学染色比较,分析新辅助化疗疗效与生物标志物改变情况,以及二者的关系、影响因素。结果:在76例新辅助化疗的患者中,达到病理完全缓解（pCR）的患者有14例(18.4%),临床有效率达75.00%。对新辅助化疗疗效的相关因素分析,发现雌激素受体（ER）、孕激素受体（PR）状态与疗效相关（P均<0.05）。进一步对14例达到pCR患者的生物标志物进行分析,ER阴性的患者有10例(71.4%)、PR阴性的患者有9例(64.3%)。对比生物标志物,发现新辅助化疗患者Ki-67改变差异有统计学意义（P＜0.05）,而ER、PR、p53改变情况差异无统计学意义（P均＞0.05）。结论:新辅助化疗具有较高的临床缓解率,新辅助化疗疗效与ER、PR状态有关,ER、PR表达较弱者相对较容易达到pCR,并且新辅助化疗后患者生物标志物只有Ki-67改变。     

Prognostic imaging in neoadjuvant chemotherapy of locally-advanced breast cancer should be cost-effective

Introduction The use of neoadjuvant chemotherapy in cases of locally advanced breast cancer has been steadily increasing, and is also in wider use for other cancers. As a consequence, a growing number of studies have focused on the question of how best to assess the therapeutic response to various chemotherapy or systemic therapy regimens. Prognostic imaging of response to therapy early in the course of a planned chemotherapy regimen could be of considerable value, particularly if shifting to another therapy regimen would be more effective. Methods A cost effectiveness analysis was completed, specific to imaging of neoadjuvant chemotherapy response in breast cancer, to determine the dominant parameters that would make imaging systems cost effective. The cost analysis was completed with respect to a system for near infrared spectral imaging, but the costs are not dramatically different for other systems such as PET or MRI. Using a standard metric of $25,000 per discounted life year gained as a measure of a successful system. Results It is shown that system specificity and patient average life expectancy are not dominant factors. Increases in cure rate and the efficacy of the initial chemotherapy are dominant factors. As long as the initial chemotherapy was less than 90% effective, most imaging systems would be cost effective, and if the cure rate of the disease could be increased as little as 1% through a change to alternate therapy, then the cost effectiveness of the system would be acceptable. Conclusions Based upon this simple economic analysis, diagnostic imaging of neoadjuvant chemotherapy appears warranted, assuming that it can be shown that the early shift from ineffective neoadjuvant chemotherapy to a more effective one has a measurable benefit in cure rate. This study indicates that the most important issue is to assess the added benefit of individualized chemotherapy in patient management, and clinical trials in this area would then provide the data required to justify analysis of prognostic imaging procedures.     

术前介入化疗治疗宫颈癌56例疗效分析

目的:探讨宫颈癌术前介入化疗的近期疗效。方法:对56例宫颈癌患者实施术前介入化疗,抗癌药物选择顺铂、丝裂霉素、阿霉素或表阿霉素;部分病例在灌注化疗(2/3量抗癌药物)后用携带有抗癌药物(1/3量)的明胶海绵颗粒栓塞肿瘤供血动脉,观察近期临床及组织学疗效及不良反应,并对有手术指征者及时实行宫颈癌根治术。结果:56例介入化疗患者临床症状缓解率为100%,肿瘤消退情况8例完全缓解(CR),35例部分缓解(PR),13例无变化(NC),无疾病进展(PD),总有效率为76%,与化疗前相比肿瘤体积显著缩小(P<0.05)。56例标本严格按规定进行组织学评定,组织学有效率为82.1%(46/56),组织学完全缓解率为10.7%(6/56)。51例患者介入化疗后顺利完成根治手术,手术切除率达91%。仅有5例中、晚期宫颈癌病人无法手术,改用放疗。结论:宫颈癌术前介入化疗可以改善临床症状,缩减肿瘤体积和范围,降低肿瘤分期、提高手术切除率及减少术中出血,是一种安全、有效的局部治疗方法。     

HR+/HER2-乳腺癌新辅助治疗及疗效预测指标研究进展#br#

激素受体阳性/人表皮生长因子受体 2 阴性(HR+/HER2-)乳腺癌对辅助化疗疗效尚不理想，而将新辅助疗法应用于局部晚期乳腺癌已成为一种安全有效的方案。但新辅助治疗的最佳治疗方案仍存在诸多争议，对于新辅助治疗的预测因子的价值和临床应用前景尚不明确。新辅助方案之间的联合应用是否进一步增加疗效，目前仍有争论。新辅助治疗在HR+/HER2-乳腺癌中的应用及预测相关指标具有很好的前景。该文根据最新研究成果，从新辅助化疗方案、新辅助内分泌与新辅助化疗的比较、新辅助化疗联合新辅助内分泌治疗，CDK4/6抑制剂联合内分泌治疗、新辅助治疗各疗效预测指标等方面进行综述。     

早期三阴性乳腺癌治疗模式及新辅助治疗研究进展CSCD

三阴性乳腺癌(TNBC)侵袭性强,易早期复发转移,预后较差,并具有明显的异质性。改善TNBC患者长期预后仍是乳腺癌治疗中所面临的挑战,需要更多的临床证据来指导治疗策略的选择。本文对可手术TNBC患者常规治疗模式及辅助化疗方案的选择、先化疗后手术的治疗模式探索、优化新辅助治疗方案的研究进展等方面进行综述,以期为TNBC治疗的临床实践及研究提供参考。     

Neoadjuvant and adjuvant chemotherapy for high-risk localized prostate cancer

Opinion statement The optimal treatment strategy for patients with high-risk localized prostate cancer remains unknown. Definitive local treatments such as radical prostatectomy and external beam radiotherapy cure only a minority of these patients. Recent efforts have been made to reduce the risk of recurrence and delay progression to symptomatic hormone-refractory disease by using chemotherapy before, during, or after definitive local therapy. Chemotherapy is an effective modality in the treatment of hormone-refractory prostate cancer. Studies have established its role in the palliation of symp-toms in patients with hormone-refractory disease, though a survival benefit remains to be demonstrated. Prospective randomized trials are underway to test the hypothesis that neoadjuvant and adjuvant chemotherapy may improve survival rate in patients with high-risk localized prostate cancer. The data currently available from nonrandom-ized trials have not yet established the exact role of neoadjuvant and adjuvant che-motherapy and its potential impact on survival. However, preliminary data suggest that chemotherapy, when administered in concert with definitive local therapy, may be promising in patients with locally advanced prostate cancer. Randomized clinical trials are ongoing to see if neoadjuvant and adjuvant chemotherapy will translate into an improved clinical benefit for the patient, and participation by patients is para-mount. We review the recent literature regarding the use of neoadjuvant and adjuvant chemotherapy in patients with locally advanced prostate cancer.